Parinaud syndrome: Any clinicoradiological correlation?

Area of Science:

• Neuro-ophthalmology
• Neuroradiology
• Pediatric Neurology

Background:

• The relationship between MRI findings and clinical characteristics in Parinaud syndrome (PS) is not well-defined.
• Magnetic resonance imaging (MRI) aids in localizing lesions causing PS.
• This study compares neuro-ophthalmological findings in PS patients with intrinsic versus extrinsic brainstem lesions.

Purpose of the Study:

• To compare neuro-ophthalmological findings in patients with Parinaud syndrome (PS) caused by intrinsic (intra-axial) versus extrinsic (pineal gland tumor) brainstem lesions.
• To investigate the influence of hydrocephalus on clinical presentation in PS.
• To evaluate the prognosis of PS based on lesion type and hydrocephalus.

Main Methods:

• Retrospective review of medical records of 26 patients with PS evaluated between 2000 and 2016.
• Categorization of lesions as intrinsic (brainstem) or extrinsic (pineal gland tumor).
• Comparison of neuro-ophthalmological findings and correlation with hydrocephalus grade.

Main Results:

• No significant difference in neuro-ophthalmological findings between intrinsic and extrinsic lesions causing PS.
• Hydrocephalus was associated with a higher number of clinical findings, particularly in patients with moderate brainstem lesions (65% vs. 29%).
• Low-grade hydrocephalus showed more findings in intrinsic lesions (40%) compared to extrinsic (0%).

Conclusions:

• Neuro-ophthalmological findings in Parinaud syndrome do not differ based on whether the lesion is intra-axial or extra-axial.
• The presence and grade of hydrocephalus are critical factors influencing the clinical presentation of PS.
• The overall prognosis for PS may be less favorable than commonly perceived, especially when hydrocephalus is present.